MANAGER, MEDICAL CLAIMS

Location
Virginia Beach, VA
Posted
Sep 06, 2016
Closes
Mar 22, 2017
Function
Management
Industry
Healthcare
Hours
Full Time
Job Description:
As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission to “improve health every day.” This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for health and service excellence while benefiting from a culture of opportunity, learning, career growth, and support - every day.

We are seeking a dynamic and versatile leader for the role of Claims Manager at our Virginia Beach, Virginia Operations. The ideal candidate will possess experience in leading a group of multi-level claims and operations individuals as well as a passion for managing all areas pertaining to the complexities of claims in a goals oriented manner.

Claims Manager is responsible for sustaining and developing departmental policies and procedures, providing oversight to staff responsible for claims processing activities, and ensuring that the organization¿s service, quality, productivity, and financial standards or goals are achieved. Oversee high dollar, complex claims auditing, monitor claims interest, perform detailed claims analyses and compose correspondence and/or detailed reports. Monitor and oversee direct reports to include Team Coordinators and employees. Assist with internal and external audits by thoroughly analyzing all errors and grievances. Create new claims policies or make recommendations to existing policies in the Claims P&P

Education Level
Bachelor's Level Degree

Experience
Required: Related - 3 years

Preferred: None, unless noted in the “Other” section below

License
None, unless noted in the “Other” section below

Skills
None, unless noted in the “Other” section below

Other
3 years of health plans claims disbursements required. Previous experience managing claims department or acting at Team Lead, Team Coordinator or Senior Claims partner required.